Nikolsky's sign

Nikolsky's sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed.

Considerations

Nikolsky's sign is either positive or negative. A positive result may be present in several different medical conditions. People with a positive sign have loose skin that slips free from the underlying layers when rubbed. The area beneath is pink and moist and usually very tender.

Typically, your health care provider will test for this sign simply by twisting a pencil eraser against your skin. If positive, a blister will form in the area, usually within minutes.

Causes of Nikolsky's sign

• Autoimmune condition (Pemphigus vulgaris)
• Bacterial infection ( Scalded skin syndrome)
• Toxic drug reaction (Toxic epidermal necrolysis)

When to Contact a Health Professional

Call your health care provider if you or your child develop painful loosening, redness, and blistering of the skin without an obvious cause.

The conditions associated with Nikolsky's sign are serious, and most people are sent to the hospital. You will be asked for your medical history and given a physical examination. You may be given fluid and antibiotics through a vein (intravenously).

Your doctor may ask the following questions:

• When did you first notice that the skin was red or blistered?
• What other symptoms occur at the same time?

Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 90.

Schumann-Gable N. Dermatology. In: Custer JW, Rau RE, eds. The Harriet Lane Handbook. 18th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 8.

Nikolsky's sign	Skin layers

Review Date: 3/11/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Roy Colven, MD, Dermatologist, Associate Professor of Medicine, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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